Focal therapy: Current status and future directions
Decision Support Techniques
© Springer-Verlag France 2015.Advances in understanding the natural history and molecular characterization of prostate cancer have ushered in an era of expanding treatment options for patients with localized disease. Focal ablative technologies have emerged as innovative, organ-sparing management strategies to eradicate tumors and preserve quality of life by decreasing posttreatment morbidity. Controversy surrounding the use of focal therapy involves the rationale for targeting an index lesion (as opposed to all cancer in the gland) and the possibility of understaging and undertreatment. The accurate assessment of disease risk remains imperfect, as it depends on the known limitations of biopsy and imaging data. Despite improvements in characterizing low-risk disease with the use of confirmatory biopsies or multiparametric MRI, studies are needed that will establish methods for effectively monitoring the disease after focal therapy to identify disease progression. The potential value of focal therapy has shifted from treating very low-risk cancer to treating higher-risk cancers early in their development, with the intent of providing effective local cancer control with negligible impact on quality of life. Coordinated efforts are therefore needed toreclassify localized disease states based on our current biological understanding of prostate cancer and to standardize designs for prospective clinical trials that can define the clinical benefit of focal therapy in men with prostate cancer. In the future, a tailored approach to prostate cancer management will offer a range of effective treatment options in which active surveillance, focal therapy, and radical surgery or radiotherapy form a continuum of complementary therapies.
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